Ibrutinib-induced pyoderma gangrenosum.

710 started an oral ibrutinib therapy (3 × 140 mg/d), due to B-CLL. An ulcer biopsy revealed lymphocyte and neutrophil infiltration. No histopathologic signs of carcinoma or vasculitis were observed. After consultation with a hematologist, a tentative diagnosis of ibrutinib-induced pyoderma gangrenosum (PG) was established. In addition to ibrutinib discontinuation, daily prednisone dose was increased to 60 mg (7.3 mg/kg/d), and cyclosporin A therapy was started (150 mg twice daily; 3.3 mg/kg/d). After 10 days, a clinical improvement was observed, with pain and exudate reduction. In addition, the borders of the ulcers became flattened. The doses of corticosteroids and cyclosporin A were slowly tapered. After 6 weeks, the healing process was almost complete. PG is a noninfectious neutrophilic skin disease, with a reported incidence of 3 to 10 cases/mln/y, affecting mostly people between 20 and 50 years old. The disease usually starts as a pustule or nodule, rapidly evolving to a painful ulcer with A 64-year-old man with a history of B-cell chronic lymphocytic leukemia (B-CLL) diagnosed 8 years earlier, with concomitant diabetes, permanent atrial fibrillation, and benign prostate hyperplasia presented with multiple, painful, ulcerative skin lesions that had occurred 2 months before. The first lesion developed on the left lower limb as a pustule rapidly evolving to an enlarging, painful skin ulcer. The following lesions occurred on the right lower limb, abdominal wall, left forearm, right buttock area, and, periungually, on the fourth finger of the right hand (FIGURE 1A and 1B). Despite receiving topical and systemic (prednisone, 30 mg/d) treatment, the progression of the disease was observed. Otherwise, the patient was in good general condition, with no serological and clinical signs of infection. Owing to the presence of comorbidities, he was treated with gliclazide (30 mg/d), sotalol (40 mg/d), dabigatran (2 × 150 mg/d), and tamsulosin (0.4 mg/d). Additionally, 6 months before hospital admission, he had